title: Predictors of implantable pulse generator placement after sacral neuromodulation: who does better?
abstract: OBJECTIVE
  Numerous studies have documented a relationship between provider variables, including surgeon volume and specialty, and outcomes for surgical procedures. In this study we analyzed claims data from a Medicare database to analyze outcomes of sacral neuromodulation (SNM) with respect to both provider and patient factors.
  
  
  METHODS
  A 5% random sample of Medicare beneficiaries from 1997 to 2007 was the data source. Data retrieved included demographic information, ICD-9 diagnosis codes, and CPT procedure codes. Multivariate analysis was performed to identify predictors of progression to implantable pulse generator (IPG) implantation.
  
  
  RESULTS
  After stage I testing, urologists were more likely than gynecologists to proceed to IPG placement (Center for Medicare and Medicaid Services: 49% vs. 43%, p < 0.0001). After percutaneous testing, gynecologists were more likely than urologists to proceed to battery placement (63% vs.44%, p = 0.005). Among the patient variables analyzed, women were more likely than men to progress to battery placement. Patients treated by high-volume providers had higher rates of IPG placement after formal stage I trials (71% vs. 33%, p < 0.0001).
  
  
  CONCLUSIONS
  The rate of IPG implantation after SNM was greater among high-volume providers. Women had better outcomes than men. Further research may better define the relationship between outcomes of sacral neuromodulation and specific etiology of voiding dysfunction.
authors.affiliation: Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Jennifer T
authors.initials: JT
authors.lastname: Anger
authors.forename: Anne P
authors.initials: AP
authors.lastname: Cameron
authors.forename: Rodger
authors.initials: R
authors.lastname: Madison
authors.forename: Christopher
authors.initials: C
authors.lastname: Saigal
authors.forename: J Quentin
authors.initials: JQ
authors.lastname: Clemens
mesh_terms: D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000639:trends; D011237:Predictive Value of Tests; D012447:Sacrum / Q000502:physiology*; D012737:Sex Factors; D062187:Spinal Cord Stimulation / Q000295:instrumentation* / Q000379:methods* / Q000639:trends; D014481:United States
keywords: Claims data; InterStim; provider specialty; provider volume